Image-guided video-assisted thoracoscopic surgery for small ground glass opacities: a case series

Abstract

Background: This case series demonstrated the feasibility of the image-guided video-assisted thoracoscopic surgery (iVATS) for localization and removal of ground glass opacities (GGOs). The procedure was performed in a hybrid operating room (OR) using C-arm cone-beam computed tomography (CBCT) equipped with a laser-guided navigation system.

Methods: Between October 1st 2016 to July 31st 2017, 14 consecutive patients presenting with GGOs underwent iVATS procedure. The efficacy and safety of the procedure were assessed through a retrospective chart review.

Results: The median GGOs size was 7 mm [interquartile range (IQR): 4-10 mm] with a median depth-to-size (D-S) ratio of 1.16 (IQR: 0-2.3). All of the lesions were visible on intraoperative CBCT images and localizations were successful in all patients with a median localization time of 22 min (IQR: 16-44 min). No patient required a conversion to thoracotomy. There was no operative mortality and the median length of postoperative stay was 4 days (IQR: 3-6 days). The final pathological diagnoses were as follows: primary lung cancer (n=6), lung metastases (n=2), and benign lung lesions (n=6).

Conclusions: Our study suggests the iVATS could be a helpful tool for single-stage detection and removal of GGOs.

Keywords: ARTIS zeego; Computed tomography (CT); ground glass opacities (GGOs); video-assisted thoracoscopic surgery (VATS).

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Image-guided VATS (iVATS) workflow (13). (I) Preoperative planning on traditional computed tomography; (II) iVATS procedure was performed in a hybrid OR, with a C-arm CBCT and a Magnus surgical table; (III) After anesthesia, the patient was placed in the planned position; (IV) Pre-procedural CBCT scan for needle path planning; (V) Needle entry guided by laser-target cross; (VI) Post-procedural CBCT scan for needle path confirmed; (VII) Tumor resection with hook wire guided. Available online: http://www.asvide.com/articles/1752

Figure 2

The arrangement of a hybrid OR, which included a C-arm cone-beam computed tomography (CBCT) and a Magnus surgical table.

Figure 3

Patient positioning for iVATS. All pipelines were gathered and align within the edge of table to avoid any entanglement with the rotating C-arm.

Figure 4

The process of needle puncture. (A) CBCT image for needle pathway planning; (B) the needle entry point and angulation were visualized by projecting a laser-target cross onto the patient’s surface according to planned needle pathway.